7 NURSE WAY - BUILDING INSPECTION (3) Commonwealth of Massachusetts
Sheet Metal Permit
Fstimated Job Cost: S SbDD Pcrmit Pce: S S
Plans Submitted: YES NO_ Plans Reviewed: YES �.NO
Business License tt C(����6�� Applicant License t# U
Business hilbrmation: Property Owner/Job Location Information:
Name: '�2> �v)p ((�H d_vC_ Namc: Q wAc 1 �U��1e�1SL C
Street: Z{ "A�" Street:
City/'town: (�) D( .. V" S-MVN City/rown: E""
Telephone: C'n'9 �J� [(`� Telephone: c:�t I 'b J l —I `] r-7 0S�
Photo I.D. required/Copy of Photo I.D. attached: YES o(� NO
swrr iw:d
J-1 / 1-(-r restricted license
J-2/ M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. tt. / 2-stories or less
Residential: 1-2Family (Y--- Multi-family_ Condo/Townhouses_ Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. -P—Z- over 10,000 sq. ft. _ Number of Stories:
Shect metal work to be completed: New Work: V4— Renovation:
1IVAC Metal Watershed Routing_ Kitchen Exhaust System
Metal C'hinmey/ Vents_ Air Balancing
Provide detailed description of work to be done: 1
`�vtiSrl 1p�v -f�cc�
- f� =�y S7t-' !-'7C-(o�� red- nA e eS
—-------------
INSURANCE COVERAGE:
I have a current liability Insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes� ��\��\o ElIf you have checked Yes, Indicate the type of coverage by checking the appropriate box below:
A liability insurance policy IA_ Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this bos11;Fhereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit Issued for this application will be
In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation Installation: YES_NO
Progress ❑tspectlonS
Date Continents
Final Inspection
Date Comments
Type of License:
By _— ❑ Master 1
rifle Master-Restricted
Cltyr7own ❑Journeyperson
Signature of Licensee
Permit x �1
- ❑Journeyperson-Restricted License Number p�
rod 5 ❑
Check at .vsr.v.m.us.;lovhllll
Inspector Signature of Permit Approval